TAMPA — The Hillsborough County Sheriff's Office and the private company that provides medical care to county prisoners paid $1 million in a wrongful-death settlement this year to the children of a Tampa man who spent approximately 36 hours in jail without treatment while suffering a fatal stroke.
Allen Daniel Hicks Sr., 51, was found stopped in his car on the side of Interstate 275 by a sheriff's deputy and a Florida Highway Patrol trooper the morning of May 11, 2012. Passers-by had called 911 after they saw Hicks' Chevy Cavalier swerving west into a guardrail, records of the incident show.
Speaking incoherently and unable to move his left arm, Hicks was arrested on a charge of obstructing a law enforcement officer when he did not respond to commands to exit his car. Just after noon, he was booked into the Orient Road Jail.
Hicks did not receive a medical screening, but was put in a cell where he lay facedown on the floor or tried to crawl using the one working side of his body. On the night of May 12, soaked in his own urine, his brain choked of blood, he was at last taken to Tampa General Hospital and diagnosed with an ischemic stroke. He slipped into a coma and died within three months.
The troubling story of Hicks, a popular baseball coach and former employee of the Hillsborough County School District, is illuminated in court records that describe jail officials' hefty payout to his children as well as ongoing litigation against other agencies. Internal Sheriff's Office memos and jail surveillance video largely corroborate the account in legal documents.
The failure to provide potentially life-saving treatment for Hicks as he suffered the early stages of a stroke raises questions about the quality of medical care in Hillsborough County jails, where for years a South Florida company has held a lucrative contract to treat prisoners.
That company, Armor Correctional Health Services Inc., paid $800,000 to Hicks' estate, according to an out-of-court settlement approved in February by a probate judge. The Hillsborough County Sheriff's Office paid an additional $200,000.
"It is clear that mistakes were made by Hillsborough County Sheriff's Office employees and contracted medical staff employed by Armor Correctional Health Services" in the handling of Hicks, the Sheriff's Office said in a statement about the case to the Tampa Bay Times. "The Hillsborough County Sheriff's Office took immediate responsibility for its actions and accountability for its mistakes by conducting a thorough review of the entire matter and working with Hicks' family through their legal representatives to reach an amicable settlement."
Sheriff's Office documents also indicate the agency instituted new training on recognizing stroke symptoms for deputies and revoked the security clearance of two Armor administrative employees, effectively removing their ability to work in the jail. (The company is still under contract to provide medical services for Hillsborough County prisoners.)
Armor Correctional officials declined to comment on Hicks' case, citing patient privacy laws.
In a general statement about the company's practices in Hillsborough County, spokeswoman Melisa Chantres said Armor "has nurses around the clock at the jail conducting immediate health screenings for each person entering … they seek to identify all medical and mental health problems, including acute conditions such as stroke and injury or chronic illnesses such as diabetes and schizophrenia."
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Hicks' story is all the more notable at a time when doctors and nurses are striving to drive home to the public the importance of promptly recognizing strokes, whose harm to the brain is compounded every minute that passes without treatment.
"I think (his death) could have been avoided had proper procedures been followed," said Vernon Slater, baseball coach at Middleton High School and a close friend of Hicks. "It was just bad the way they handled things with him, because I really think it could have been prevented."
Under the settlement terms, Hicks' children and their attorneys cannot discuss the circumstances of his death. His sister-in-law, Edna Hicks of Tampa, said his relatives are "still angry" about the episode.
"It's been almost a year, but we're still trying to get past it," she said. "It's been rough on the family."
'An erratic state'
Slater said he had known Hicks for about 15 years and spoke to him almost every day. The men shared a passion for baseball. Slater said Hicks was a coach with him at Middleton for six years, and the two also coached Little League together.
Slater said one story about his genial and outgoing friend always comes to mind. He and Hicks were once trying to prod a reluctant group of Little League ballplayers to take the field on a rainy day. While the team cowered in the dugout, Hicks took a lap of the bases and dove into a mud-encircled home plate with a head-first, Pete Rose-style slide.
See? He said, according to Slater. It's not going to hurt you.
"The kids loved him, man," Slater said. Hicks was employed as an aide for students with special needs in 2005 and 2006, according to Hillsborough School District records.
Shortly before 9 a.m. on Friday, May 11, 2012 — two days before he was scheduled to coach a Little League game — Hicks was observed driving erratically in the northbound lanes on I-275 near Bearss Avenue. Another driver had called 911 about a "possible drunk driver," according to a sheriff's report.
Hicks' criminal record before that morning consisted of arrests in 2003 and 2011 on charges of driving with a suspended license, according to state and local records. Hillsborough sheriff's records indicate he was also detained in 1995 for contempt of court.
Sheriff's Deputy Justin Lunsford arrived, along with Highway Patrol Trooper Richard Guzman and a Hillsborough Fire Rescue engine. Hicks' car was stopped against the guardrail in the left emergency lane and his driver's side mirror was broken off, Lunsford's report states. Someone had placed Hicks' keys on the roof of his car.
Lunsford noted that he "did not detect the odor of any alcoholic beverages" on Hicks and that he was "behaving in an erratic state … when asked for his driver's license he picked up the lid to the center console and dropped it closed." Hicks continued to claw at the console until Guzman reached inside it for him and retrieved his wallet.
Lunsford and Guzman became worried when Hicks did not obey commands to show his hands and exit the car. Seeing that Hicks' left hand was drooping into the side pocket of the driver's door, the officers pulled their handguns.
Hicks still acted befuddled, saying to Lunsford, "that's a 9-millimeter semiautomatic gun that you have," the report states. After ascertaining Hicks was unarmed, Lunsford and Guzman pulled him out of the car through the passenger door and handcuffed him.
In a lawsuit filed last month against Hillsborough County Fire Rescue and the Florida Department of Highway Safety and Motor Vehicles, agencies that have not reached a settlement with Hicks' heirs, attorneys for his estate say he was examined at the scene by paramedics who "found no medical problems." The paramedics nevertheless suggested Hicks be transported to St. Joseph's Hospital for a psychiatric evaluation, according to the complaint.
Capt. Nancy Rasmussen, spokeswoman for the Highway Patrol, declined to comment on the incident, citing the pending litigation. Hillsborough Fire Rescue spokeswoman Jessica Damico also declined to comment because of the lawsuit.
Guzman is also named individually as a defendant in the estate's complaint. Guzman could not be reached for comment.
Lunsford's report makes no mention of plans to take Hicks to a hospital. In fact, Hicks was not taken to St. Joseph's, but was transported by Guzman to the Orient Road Jail, where he was booked at 12:23 p.m. on May 11, jail records show.
'Time is brain tissue'
Like a heart attack, ischemic stroke is a medical catastrophe that stalks the adult population of the United States. Accounting for roughly 9 in 10 strokes, according to the American Stroke Association — hemorrhagic stroke, involving bleeding within the brain, is far less common — an ischemic stroke occurs when a clot blocks a vessel that carries blood to the brain.
Prompt treatment is key. Kelly Cullen, director of patient care services at Mease Dunedin Hospital, said the most effective treatment — a "clot buster" drug injected into the bloodstream that dissolves the obstruction to the brain — can be used with success for up to four and a half hours after the onset of a stroke.
After that, treatment can still be applied for another several hours, albeit with a lower success rate. Beyond eight hours, Cullen said, a stroke has usually caused irreversible damage to the parts of the brain where blood flow was blocked.
"When you're having a stroke, time is brain tissue," Cullen said. "The earliest intervention that you can do for a stroke has the best outcome for a patient."
Health professionals are taught to watch for a recognizable cluster of symptoms caused by loss of blood to the brain during ischemic strokes — notably impaired speech, confusion and weakness or lack of coordination on one side of the body.
When he was jailed on May 11, Hicks was showing at least several of these signs.
Surveillance video provided by the Sheriff's Office in response to a request from the Times shows Hicks' inert left leg was dragging from the wheelchair deputies used to move him into the jail. According to his estate's lawsuit, he was unable to wield a pen to sign intake forms.
A Sheriff's Office internal review later found Hicks was put in a holding cell without a medical screening, despite the presence of three nurses who stood watching him. One nurse, the investigation states, "apparently determined … that Hicks was feigning injury and could walk."
Jail surveillance video shows Hicks lying on the floor of the cell, face-down and mostly motionless. From time to time his right limbs twitched, or he tried to crawl forward using only the right side of his body.
Hours passed. At 3:25 p.m. he received his first medical assessment, according to the internal review. Armor personnel did not diagnose his stroke, but suggested he be monitored as a psychiatric patient. In conversations with jail personnel, Hicks attributed his lack of mobility to chronic back problems.
At about 5:30 p.m. he was transferred to the Falkenburg Road Jail, where deputies checked on him every 15 minutes. Not until 12:10 p.m. on May 12, a full day after he was booked, did he finally receive a psychiatric evaluation by a social worker.
"The employee noted that (Hicks) could not engage, smelled of urine, and complained of incontinence, and indicated that he could not use his legs or walk," the lawsuit states. "His behavior was inappropriate, he had decreased psychomotor activity" and was "delusional with a poor memory."
It was not until later that night that Armor employees began to come to terms with Hicks' serious condition. According to the Sheriff's Office review, medical notes indicate Hicks was found "lying in urine in the cell."
At 10:24 p.m., the review states, a nurse who examined him concluded he "displayed symptoms of a potential stroke." But two more hours passed as Armor health workers continued to assess Hicks and debate the right course of action.
He was finally transported to Tampa General Hospital at 12:20 a.m. on May 13, according to the sheriff's investigation.
It had been 35 hours and 57 minutes since Hicks was booked into the Orient Road Jail.
At the hospital, the lawsuit states, he "was diagnosed as having suffered a subacute ischemic stroke, which he had been suffering from for a considerable length of time … he had suffered severe brain damage and it was too late to administer the appropriate treatment."
According to an internal memo on the legal settlement by Thea Clark, an attorney for the Sheriff's Office, an unidentified neurosurgeon who treated Hicks at Tampa General was "extremely critical of the medical care provided by Armor, as well as Armor and HCSO's delay in transferring Mr. Hicks to the hospital."
It is unclear exactly when Hicks' stroke began, though the circumstances of his arrest suggest its onset could have occurred while he was driving his car the morning of May 11. But the outcome is not in question: Hicks entered a coma and died from the stroke and related complications on Aug. 7.
In an internal memo dated July 19, 2012, Hillsborough sheriff's Col. James Previtera presented the findings of the agency's internal review of the jail's handling of Hicks.
Previtera wrote that "there is basis for immediate retraining related to the signs and symptoms of specific medical conditions, especially those subtle indicators of stroke."
He also removed the jail security clearance of an Armor administrator and his assistant, citing "improper handling" of Hicks' medical records and "conflicting statements about the existence of the records."
The Sheriff's Office stopped short of a broader rupture with the Miami-based company, which according to its website provides medical services at jails in Florida and four other states. Armor still handles inmates' care in Hillsborough County.
The terms of the firm's contract with the Sheriff's Office allow for a base pay rate ranging from roughly $53,000 to $60,000 per day, depending on the size of the jail population.
Previtera wrote in his memo that he had been in touch with Armor CEO Bruce Teal to express "extreme dismay with the manner in which his staff assessed and treated Mr. Hicks. The matter is the subject of continued internal review by Armor and corrective action is expected."
Meanwhile, Clark's internal memo on the case suggested the settlement with Hicks' heirs, while sizable, was in the best interests of the Sheriff's Office.
"There is no doubt in my mind," she wrote, "that if plaintiff's claims were presented to a jury, plaintiff would receive a judgment against HCSO in amounts that far exceed $200,000."
News researcher John Martin contributed to this report. Peter Jamison can be reached at firstname.lastname@example.org or (813) 226-3337. Follow him on Twitter @petejamison.